Myocardial stunning

In cardiology, stunned myocardium is a state when some section of the myocardium (corresponding to an area of a major coronary occlusion) shows a form of contractile abnormality. This is a segmental dysfunction that persists for a variable period of time, about two weeks, even after ischemia has been relieved (by for instance angioplasty or coronary artery bypass surgery). In this situation, while myocardial blood flow (MBF) returns to normal, function is still depressed for a variable period of time.

Myocardial stunning
SpecialtyCardiology 

Myocardial stunning is the reversible reduction of function of heart contraction[1] after reperfusion not accounted for by tissue damage or reduced blood flow.[2]

After total ischemia occurs, the myocardium switches immediately from aerobic glycolysis to anaerobic glycolysis resulting in the reduced ability to produce high energy phosphates such as ATP and Creatinine Phosphate. At this point, the lack of the energy and lactate accumulation results in cessation of contraction within 60 seconds of ischemia (i.e. Vessel Occlusion). Subsequent to this is a period of "myocardial stunning," in which reversible ischemic damage is taking place. At approximately 30 minutes after the onset of total ischemia the damage becomes irreversible, thereby ending the phase of myocardial stunning.

Clinical situations of stunned myocardium are:

  • acute myocardial infarction (AMI)
  • after percutaneous transluminal coronary angioplasty (PTCA)
  • after cardiac surgery
  • 'neurogenic' stunned myocardium following an acute cerebrovascular event such as a subarachnoid hemorrhage
  • in patients undergoing chronic hemodialysis, chronic myocardial stunning may lead to heart failure

References
  1. Myocardial+Stunning at the US National Library of Medicine Medical Subject Headings (MeSH)
  2. Grund F (February 2001). "[Three cardiac mysteries--stunning, hibernation and ischemic preconditioning]". Tidsskr. Nor. Laegeforen. (in Norwegian). 121 (4): 440–4. PMID 11255859.

Further reading
Classification


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